title: The outcomes of perinatal surgical services in rural British Columbia: a population-based study.
abstract: BACKGROUND
  A substantial number of small surgical services in rural Canada have been discontinued in the past 15 years because of difficulties recruiting and retaining practitioners, health care restructuring and a lack of a coherent evidence base regarding the safety of small services. The objective of this study was to examine the safety of small perinatal surgical services.
  
  
  METHODS
  We accessed perinatal data for singleton births that occurred in British Columbia between Apr. 1, 2000, and Mar. 31, 2007. We defined hospital service levels, population catchment areas surrounding each hospital and the postal codes linked to those catchment areas. Births were linked with specific catchment areas and amalgamated by service level. We made comparisons among service strata populations and adjusted for potentially confounding characteristics.
  
  
  RESULTS
  A total of 87 294 births occurred during the study period. The births were distributed across 6 strata of services, which ranged from no local maternity services to services supported by obstetricians. Fifteen catchment areas were served by general practitioners with enhanced surgical skills (GPESSs), and 9174 births were included from this obstetric service level. Outcomes for surgical services provided by GPs compared favourably to those provided by obstetricians.
  
  
  CONCLUSIONS
  Our results suggest that small surgical services supported by GPESSs are a safe health services model to meet the needs of rural women and families.
authors.affiliation: Centre for Rural Health Research; Vancouver Coastal Health Research Institute; Department of Family Practice, University of British Columbia, Vancouver, BC.
authors.forename: Stefan
authors.initials: S
authors.lastname: Grzybowski
authors.forename: Kathrin
authors.initials: K
authors.lastname: Stoll
authors.forename: Jude
authors.initials: J
authors.lastname: Kornelsen
mesh_terms: D001955:British Columbia / Q000453:epidemiology; D002391:Catchment Area, Health; D005260:Female; D013502:General Surgery / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000458:organization & administration*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012042:Registries; D012189:Retrospective Studies; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population